Loperamide Simethicone

Loperamide Simethicone Brand Names

Imodium Advanced | Imodium Multi-Symptom Relief

What is Loperamide Simethicone

Loperamide and simethicone are used together to treat acute diarrhea accompanied by bloating, cramps, and pressure.

Loperamide treats diarrhea by slowing intestinal motility, inhibiting fluid and electrolyte secretion and/or increasing water absorption.

Simethicone reduces gas symptoms by dispersing and preventing the formation of mucus-surrounded gas pockets in the GI tract.

Simethicone works by decreasing the surface tension of gas bubbles in the GI tract thereby allowing the foamy gas bubbles to coalesce into one large pocket of gas which is easily eliminated.

Tolerance to the antidiarrheal effect of loperamide has not been observed, and it does not appear to produce physical dependence.

However, intentional misuse or abuse of high loperamide doses has been observed in patients attempting to self-treat opioid withdrawal or achieve an euphoric feeling.

These intentional overdoses, along with elevated loperamide concentrations resulting from drug interactions, have been associated with at least 48 cases of loperamide-induced cardiac events. Of these 48 cases, 31 required hospitalization and 10 resulted in death.

Due to the severity of these adverse events, the FDA issued a Drug Safety Communication in June 2016 to alert health care providers of the potential for serious cardiac events following use of high loperamide doses.

Also, fluid and electrolyte depletion often occur in patients who experience diarrhea.

The use of loperamide simethicone does not preclude the need for appropriate fluid and electrolyte therapy.

Imodium Advanced was approved in 1997; later renamed Imodium Multi-Symptom Relief.

Generic products were first approved in October 2002

Indications

  • diarrhea

For self-treatment of acute diarrhea accompanied by bloating, cramps, pressure or flatulence

Side Effects

  1. abdominal pain
  2. anaphylactic shock
  3. anaphylactoid reactions
  4. angioedema
  5. bullous rash
  6. constipation
  7. dizziness
  8. drowsiness
  9. dyspepsia
  10. erythema multiforme
  11. flatulence
  12. headache
  13. ileus
  14. nausea
  15. pruritus
  16. rash
  17. Stevens-Johnson syndrome
  18. toxic epidermal necrolysis
  19. toxic megacolon
  20. urinary retention
  21. urticaria
  22. vomiting
  23. xerostomia

Monitoring Parameters

  • laboratory monitoring not necessary

Contraindications

  • abdominal pain
  • acquired immunodeficiency syndrome (AIDS)
  • breast-feeding
  • cardiac arrest
  • cardiac arrhythmias
  • children
  • constipation
  • driving or operating machinery
  • dysentery
  • fever
  • gastroenteritis
  • geriatric
  • hepatic disease
  • ileus
  • infants
  • infection
  • neonates
  • pregnancy
  • pseudomembranous colitis
  • QT prolongation
  • respiratory depression
  • substance abuse
  • syncope
  • torsade de pointes
  • toxic megacolon
  • ulcerative colitis

Interactions

  • Acetaminophen; Butalbital; Caffeine; Codeine
  • Acetaminophen; Caffeine; Dihydrocodeine
  • Acetaminophen; Chlorpheniramine; Dextromethorphan; Phenylephrine
  • Acetaminophen; Chlorpheniramine; Dextromethorphan; Pseudoephedrine
  • Acetaminophen; Chlorpheniramine; Phenylephrine; Phenyltoloxamine
  • Acetaminophen; Codeine
  • Acetaminophen; Hydrocodone
  • Acetaminophen; Oxycodone
  • Acetaminophen; Propoxyphene
  • Aclidinium; Formoterol
  • Albuterol
  • Albuterol; Ipratropium
  • Aldesleukin, IL-2
  • Alfentanil
  • Alfuzosin
  • Aliskiren; Amlodipine
  • Aliskiren; Amlodipine; Hydrochlorothiazide, HCTZ
  • Alosetron
  • Amantadine
  • Amiodarone
  • Amitriptyline
  • Amitriptyline; Chlordiazepoxide
  • Amlodipine
  • Amlodipine; Atorvastatin
  • Amlodipine; Benazepril
  • Amlodipine; Celecoxib
  • Amlodipine; Hydrochlorothiazide, HCTZ; Olmesartan
  • Amlodipine; Hydrochlorothiazide, HCTZ; Valsartan
  • Amlodipine; Olmesartan
  • Amlodipine; Telmisartan
  • Amlodipine; Valsartan
  • Amoxapine
  • Amoxicillin; Clarithromycin; Lansoprazole
  • Amoxicillin; Clarithromycin; Omeprazole
  • Anagrelide
  • Apomorphine
  • Aprepitant, Fosaprepitant
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  • Armodafinil
  • Arsenic Trioxide
  • Artemether; Lumefantrine
  • Asenapine
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  • Aspirin, ASA; Caffeine; Dihydrocodeine
  • Aspirin, ASA; Carisoprodol; Codeine
  • Aspirin, ASA; Oxycodone
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  • Atropine; Difenoxin
  • Atropine; Diphenoxylate
  • Atropine; Edrophonium
  • Atropine; Hyoscyamine; Phenobarbital; Scopolamine
  • Azithromycin
  • Bedaquiline
  • Belladonna Alkaloids; Ergotamine; Phenobarbital
  • Belladonna; Opium
  • Benzoic Acid; Hyoscyamine; Methenamine; Methylene Blue; Phenyl Salicylate
  • Benztropine
  • Bethanechol
  • Bismuth Subcitrate Potassium; Metronidazole; Tetracycline
  • Bismuth Subsalicylate; Metronidazole; Tetracycline
  • Boceprevir
  • Bosentan
  • Brigatinib
  • Brompheniramine; Guaifenesin; Hydrocodone
  • Brompheniramine; Hydrocodone; Pseudoephedrine
  • Budesonide; Formoterol
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  • Buprenorphine; Naloxone
  • Bupropion
  • Bupropion; Naltrexone
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  • Cannabidiol
  • Capmatinib
  • Carbamazepine
  • Carbetapentane; Chlorpheniramine
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  • Carbinoxamine; Hydrocodone; Pseudoephedrine
  • Carvedilol
  • Ceritinib
  • Chloramphenicol
  • Chlorcyclizine
  • Chlordiazepoxide; Clidinium
  • Chloroquine
  • Chlorpheniramine
  • Chlorpheniramine; Codeine
  • Chlorpheniramine; Dextromethorphan
  • Chlorpheniramine; Dextromethorphan; Phenylephrine
  • Chlorpheniramine; Dihydrocodeine; Phenylephrine
  • Chlorpheniramine; Dihydrocodeine; Pseudoephedrine
  • Chlorpheniramine; Guaifenesin; Hydrocodone; Pseudoephedrine
  • Chlorpheniramine; Hydrocodone
  • Chlorpheniramine; Hydrocodone; Phenylephrine
  • Chlorpheniramine; Hydrocodone; Pseudoephedrine
  • Chlorpheniramine; Phenylephrine
  • Chlorpheniramine; Pseudoephedrine
  • Chlorpromazine
  • Cholestyramine
  • Cimetidine
  • Ciprofloxacin
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  • Codeine; Guaifenesin
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  • Dextromethorphan; Promethazine
  • Dextromethorphan; Quinidine
  • Dicyclomine
  • Dihydrocodeine; Guaifenesin; Pseudoephedrine
  • Diltiazem
  • Diphenhydramine; Hydrocodone; Phenylephrine
  • Disopyramide
  • Dofetilide
  • Dolasetron
  • Dolutegravir; Rilpivirine
  • Donepezil
  • Donepezil; Memantine
  • Doxepin
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  • Emtricitabine; Rilpivirine; Tenofovir alafenamide
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  • Enalapril; Felodipine
  • Encorafenib
  • Enflurane
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  • Ethinyl Estradiol; Norethindrone Acetate
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  • Ethinyl Estradiol; Norgestrel
  • Etravirine
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  • Felodipine
  • Fenofibric Acid
  • Fentanyl
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  • Fingolimod
  • Flavoxate
  • Flecainide
  • Flibanserin
  • Fluconazole
  • Fluoxetine
  • Fluoxetine; Olanzapine
  • Fluphenazine
  • Flutamide
  • Fluticasone; Salmeterol
  • Fluticasone; Umeclidinium; Vilanterol
  • Fluticasone; Vilanterol
  • Fluvoxamine
  • Formoterol
  • Formoterol; Mometasone
  • Fosamprenavir
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  • Gemifloxacin
  • Gemtuzumab Ozogamicin
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  • Glasdegib
  • Glecaprevir; Pibrentasvir
  • Glycopyrrolate
  • Glycopyrrolate; Formoterol
  • Goserelin
  • Granisetron
  • grapefruit juice
  • Guaifenesin; Hydrocodone
  • Guaifenesin; Hydrocodone; Pseudoephedrine
  • Guaifenesin; Potassium Guaiacolsulfonate
  • Halogenated Anesthetics
  • Haloperidol
  • Halothane
  • Hetastarch; Dextrose; Electrolytes
  • Histrelin
  • Homatropine; Hydrocodone
  • Hydrocodone
  • Hydrocodone; Ibuprofen
  • Hydrocodone; Phenylephrine
  • Hydrocodone; Potassium Guaiacolsulfonate
  • Hydrocodone; Potassium Guaiacolsulfonate; Pseudoephedrine
  • Hydrocodone; Pseudoephedrine
  • Hydromorphone
  • Hydroxychloroquine
  • Hydroxyprogesterone
  • Hydroxyzine
  • Hyoscyamine
  • Hyoscyamine; Methenamine; Methylene Blue; Phenyl Salicylate; Sodium Biphosphate
  • Ibritumomab Tiuxetan
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  • Ibuprofen; Oxycodone
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  • Iloperidone
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  • Imipramine
  • Indacaterol
  • Indacaterol; Glycopyrrolate
  • Indinavir
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  • Iodine; Potassium Iodide, KI
  • Isavuconazonium
  • Isoflurane
  • Isoniazid, INH; Pyrazinamide, PZA; Rifampin
  • Isoniazid, INH; Rifampin
  • Istradefylline
  • Itraconazole
  • Ivacaftor
  • Ivosidenib
  • Ixabepilone
  • Ketoconazole
  • Lapatinib
  • Lasmiditan
  • Ledipasvir; Sofosbuvir
  • Lefamulin
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  • Lenvatinib
  • Lesinurad
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  • Letermovir
  • Leuprolide
  • Leuprolide; Norethindrone
  • Levalbuterol
  • Levofloxacin
  • Levorphanol
  • Linaclotide
  • Lithium
  • Lofexidine
  • Lomitapide
  • Long-acting beta-agonists
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  • Lorcaserin
  • Lubiprostone
  • Lumacaftor; Ivacaftor
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  • Macimorelin
  • Maprotiline
  • Mefloquine
  • Meperidine
  • Meperidine; Promethazine
  • Metaproterenol
  • Methadone
  • Methenamine; Sodium Acid Phosphate; Methylene Blue; Hyoscyamine
  • Methscopolamine
  • Metoclopramide
  • Metronidazole
  • Midostaurin
  • Mifepristone
  • Mirabegron
  • Mirtazapine
  • Mitotane
  • Modafinil
  • Morphine
  • Morphine; Naltrexone
  • Moxifloxacin
  • Nafcillin
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  • Nevirapine
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  • Nicotine
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  • Olanzapine
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  • Oxaliplatin
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  • Oxymorphone
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  • Pasireotide
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  • Perampanel
  • Perindopril; Amlodipine
  • Perphenazine
  • Perphenazine; Amitriptyline
  • Phenobarbital
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  • Phenylephrine; Promethazine
  • Phenytoin
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  • Potassium
  • Potassium Acetate
  • Potassium Bicarbonate
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  • Pramlintide
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  • Primidone
  • Procainamide
  • Prochlorperazine
  • Promethazine
  • Propafenone
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  • Quetiapine
  • Quinidine
  • Quinine
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